views. it was a big trial and i had to give my views what would be a reasonable settlement. so eventually, both parties accepted my judgment. it was not a judgment. it was an arbitration. it was -- they wanted to have my views. but i said to the president of the bank, i said, you know, 1995, i said no to the merger of the banks and relations and you were very unhappy with me. now you go around the world and they tell you that you guys, you're the best bankers in the world, and i said, good for you. of course you don't tell them it's because i stopped you from jumping from the bridge, but i said this is my judgment in this ca >> but i said it is my judgment in this case. you can't tell me i have no more judgment. he said yes.

so that is what we did to maintain a situation. but you have to -- but your difficulties is that it's a negotiation. there was no negotiation with me. every department which was we have the -- a very good minister, a bureaucrat and provided the committee. he had no ambition to be a leader and so on. he did have friends. he appealed to me. and i told him that he had called me at my cabinet meeting, he saidacka he said jacque you have not called me. are you mad at me? no. i said why aren't you talking me. i said i don't want to disturb you and if you're not calling me, i feel about about it so

don't call me. [laughter] >> so he said to me if they were all like you it would be sweeter to be prime minister. he said what happened to me after that and they all know i had job after job after job so they were not calling me. [laughter] >> so it was done that way. it will be -- you cannot do that in your system, unfortunately, because nobody is in charge, unfortunately. and what i find so because i was meeting with president obama bush, with president clinton. clinton was my counterpart for eight years and this was one of the frustration. your president can never deliver because of your system. and you blame him all the time. it's not fair. whoever is the president is yes

power and reward. when george bush senior went to war for the q8 he had a vote 51, 49 in the senate approval but in the case of iraq it was unanimous. but the congress could have blocked -- can block -- not the congress but the senate, i guess, can block any war because of your -- in canada it's an executive order. but the consequences is if the parliament disagree with you, you're out and you're looking for a law firm. [laughter] >> prime minister, i wonder if you could comment on the arab spring and what nato and the united states and canada is doing, pick a country, libya, egypt, syria? >> you know, it's very difficult

because we don't know what will be the result. i remember -- and we're not good at judging these things. but when we realize that -- and i talked about that and we had some initiative back then and to have a predictive of the human rights but there is a reversed side to the and now they prosecutor its former leaders in court but as they know they are going to jail, they hang around. it was days when the guys would quit and go in exile and say it's over now, more or less. so there's always two sides of these things. and one of the most telling

stories was the experience i was with the shah of iran when i was minister of trade. it was a long time ago but i was, you know -- you're lucky i wasn't minister a long time ago and being a small town lawyer acting in court, defending, i was on the defense side defending criminals and so on, among other things because in a small town you do everything. i told him that i was not -- ask him questions about human rights situation in iran under the shah. and he said to me young man, if they kick me out it will be worse than the replacement. was he right? i guess, so. so it's why when you ask me for

a definitive answer i'm always ambivalent because you don't know what will happen next. and -- and we have a good system that we call democracy but it's not perfect either. as churchill said it was a worse -- a terrible system but there is none better than that but it's not perfect. in some countries, you know, for us here, you know, i pass laws on spending on election, you know, but you're court said no limit to that. fine. but, you know, one election i was talking when hillary clinton became senator of new york city. one senator in one state i had an election the same year with 300 candidates.

the national campaign and i had to raise two thirds of the money that she had to raise to be senator of new york. here you have limit on contribution. nobody can give more than $1200 a year. there is -- they're in the time of election. there is a limit. you know, you cannot start advertising before so many days when the campaign and you stop the last five days and the campaign is only 35 days. and you guys started to run two years before and you have to raise billions of dollars. you know, it's a real problem but it's not my business. [laughter] >> but i prefer our system. but whenever i get going on my subject my friend and others of the same nature, so merci

beacoup. >> thank you, prime minister. [applause] >> a survey of large u.s. employers recently found their

health care costs have risen. this comes from the national business group on health a nonprofit association of large employers. their press conference to announce the finding is 50 minute minutes. >> so good morning and thank you all for joining us here at the national press club. i'm helen darling president on the national business group on health and with me i have craig lykens who worked on the survey and also karen marrow who also worked on the institute of health and also been heavily in

our barking group so we have two people to answer very specific questions that you have about our data. as you probably know this is a survey that we do each year in the summer and we do it then because that's the first time usually employers know and can tell us what they're actually doing for the next year. some of the later ones and early ones are sort of different benefit planning cycles so this is a key time. we also share this, obviously, with the people -- members in our organization. they're very interested in knowing what their peers are doing.

according to our data. and when you think about this and you think about what we're struggling with right now with jobs and trying to create jobs or bring people back, that is a huge fixed cost that the nation bears and the employers have to deal with and we do not doubt for a minute that the health care cost crisis are completely intertwined with the national debt crisis because of how much we spend on health care in this country especially the public sector but also it's a huge burden on businesses and exposure because it's so high and it continues to grow in a way that doesn't reflect improvements in the underlying productivity in the health industry. at a time when everything is going down or staying flat, the heck industry continues to gallop along at over 7%.

and that is really an unsustainable model for our country. now, most employers are using now cost management techniques and craig's going to talk a little bit about that. consumer risk strategies that is trying to get the consumer engaged and understanding that they too have to work to control utilization and control costs. then attention to health improvement. employers began seeing about five years ago -- they began to realize if you have a fundamentally unhealthy employee or family member in terms of problems like obesity and diabetes and smokers and a whole range of problems that, in fact, there's almost no way you can really control costs because they will cost more and more as they get older. so we see the best companies are doing cost management, consumer risk strategies and attention to health improvement simultaneously. in addition as you all know the

affordable care act has been taking an affect and it affects employers that we survey in difficulty ways. so there's two big changes. one the mandate that the government requires of employers, for example, covering the adult children up to age 26. and also the benefit mandates that are beginning to come in so they're saying you have to cover certain things or you can't have limits. those will drive up cost as well but in fairness to those who don't want to say anything negative about the affordable care act we have serious health care problems independent of the affordable care act so we have to solve these problems no matter what the impact of the health care reform is so that really is on top of a serious underlying problem so no matter what happens with the affordable care act, we still are going to struggle with this massive

problem. we surveyed our corporate service some of the largest members in the country to figure out what they're doing for 2012 so this takes effect january 2012 and these are the options that employers are being shown starting probably next month, september when they got their open enrollment packages so this is what they will see. so we ask them things about what we usually ask about and give more details about that. 83 large employers representing over 4 million employees completed this survey. we have estimated medical trend. we asked them what is your trend for this year because they actually don't know 2011 until about a quarter into 2012. and the mean in 2011 was 7.4% so they believe that's what will be happening this year. and they're estimating for their own internal budgeting purposes that in 2012, the mean will be

7.2%. now, that sounds like it might have gone down but keep in mind that's on the higher base. so 7.2% in absolute dollars is more even than the 7.4% was in absolute dollars and although we all talk about percentages, it's the absolute dollar amount that hurts jobs and hurts families because their income is either flat or if they lost their jobs they don't even have any income or they are dealing with cutback hours so the continued flat growth of -- or growth of health care is, in fact, up against an economy that we know is in serious trouble. so at this point i will turn it over to craig lykens to bring us up-to-date on the impact of health care reform from our members. >> thank you helen.

as helen mentioned one of the survey's key areas are planned design changes as a result of the provisions of the affordable care act. employers were asked a number of questions concerning a variety of provisions coming into effect over the next few years. and what changes players are making or planning to make as a result of those provisions. the first provision wes asked employers about was auto enrollment. the employers were asked what plan would they be using as the default plan for employers who did not respond during the open enrollment. the response were varied with over 27% still undecided among those employers who had already chosen a default plan the most commonly selected option was the health plan that was most affordable or least costly to the employee employee which is 27% by the is upon's another 8 penn was the default option. in regard to employers maintaining the grandfathered status of benefit options going into 2012, 23% of employers will

have at least one benefit option that will retain grandfathered planned status in 2012 while 19% will drop the grandfathered status of any benefit options that were grandfathered in 2011. in addition, nearly half of employers had no benefit options in 2011 that had kept grandfathered status. leading up to the complete ban of annual benefit limits in 2014, 27% of employers are making changes to the annual benefit limits around preventive and wellness services for 2012. and 14% are making changes to annual benefit limits for mental health and substance abuse services. it's also important to note that 59% of employers indicate they did not need to make any changes to the annual benefit limits for 2012. concerning the health exchanges, they were asked if the health exchanges would be a viable

option for certain segments of their population. notely, these are what they knew about the health exchanges as they were filling out the survey which was fielded in the month of june. over half of the employers believe that their retirees might find the health insurance exchanges as a viable option. another in our 41% might find the exchanges and options well. while 22% options no segment find the exchanges a feasible option. regarding the provision increasing the hipaa allowed wellness incentives of 27% to 30% of total cost command cainto effect in 2014, some employers are already anticipating taking advantage of that change. 19% already planned to increase their level of wellness incentive above the current 28% limit in 2014 when the provision takes effect. in anticipation of the taxation

of the federal retiree drug subsidies those who receive the subsidies are still primarily reviewing their options. a few 13% have decided to drop primary coverage for retirees in lieu of wrap-around or secondary coverage while another 13% have or will move to a waiver group plan as a result of the retiree drug subsidies. the next question employers were asked concerned medicare part d become richer and the donut hole progressive closing. those currently offering primary retiree benefits nearly all will continue to -- nearly all will continue offering primary coverage in 2012. roughly 97%. although most 61% are considering dropping primary coverage in the future. the last question we asked employers pertaining to changes due to the affordable care act involve the medicare advantage of those employers that currently depend on medicare advantage no employers had

decided to discontinue participation due to the phasing out of the medicare advantage in 2017 although half of the respondents were still undecided at this time. however, 42% did report that they would be continuing their participation in 2012 but would be reviewing their continuing participation for the future. beyond looking at changes being enacted tuto the affordable act employers were also asked questions regarding tactics and strategies for controlling costs and improving employee health while we will not go over the results of the survey, helen and i will walk you through the she could findings. the first of which is in regard to the first effective tactics for control herk costs as reported by employers. employers were asked to identify the top three tactics for control costs and the tactic that was most often selected as the most effective tactic was increasing employer cost-sharing followed by a consumer directed health plan and wellness initiatives to improve employee

health. in looking at which step or tactic was most often selected to be one of the top 3 effective tactics wellness initiatives were identified by 64% of respondents now regarding increased cost-sharing. 53% will increase the contribution to the premium cost however most are planning to do so by less than 10%. other cost-sharing tactics being implemented by some employers include in and out of network deductibles, out-of-pocket maximums and copayments and/or coinsurance for primary and specialist care. and with that i'll turn things back over to helen. >> thank you, craig. so i just want to highlight one point that craig made on this particular slide, that is in general because coinsurance has a kind of automatic increase built in so as prices go up --

if your coinsurance is 20% as opposed to a flat dollar amount, you know, you go to the doctor's office they say it's $15 or if your coinsurance is 20%, it's 20% over what the bill is. so on that -- on the slide on page 17, it mentions that the increase was to the employee percentage contribution to the premium cost and that is important because it is not just a flat amount. it's the percentage increase. now, there's less of an increase for office visits but more and more we see coinsurance which is a more subtle way, if you will, to increase what the consumers pay. and it also most importantly and the reason it's done is, if you don't use coinsurance, the consumer has no way of really paying attention to what a visit cost. a visit could be a $500 visit

with tests and everything or $150 visit. you could have a $15 co-pay for both of those but the minute you build in coinsurance, then, in fact, you bring the consumer in to the financial picture in a completely different way and that's why where we will see more and more of that. the co-pay will be the -- you know, the public sector and unions will probably keep co-pay and they'll be the only ones allowed. so we also and can about consumer directed health plan in 2012. and as you can see in the slide that you have that in 2012 first of all the full replacement is 17%, that is where no other plan is offered. so you have a consumer-directed health plan and that's your only choice but as an option, the amount of those who are offering that went up to 56%. so that is a significant change.

and the number that said no, that i have not going to do either in 2012 it went down to 27% when it was 39% in 2011 so we are clearly seeing a march towards a more afwrefs consumerist strategy and a growing realization that many employers and, frankly, i suspect the public sector, too, is coming to realize that if the consumer isn't actively damaged and have some financial stake there is absolutely no hope for our controlling health care costs in this country. so we also asked about the plan types. you may remember that there are health savings accounts which are accounts that an employee owns, an amount of money set aside use to pay for health care which have been authorized in this country for some years. but kind of under attack a couple years ago. but they are alive and well.

so we have found employers have moved 2012 75% of the plans will be a high deductible plan with a health savings account and 16% a high deductible health plan with what's called a health reimbursement account. a health reimbursement account, the big difference between an hsa and hra is the employee owns the health savings account. the employee gets a health reimbursement account for an employer but if the employee leaves the employment then they can't take it with them. they can retire from that and with that company or organization they take the hra with them but otherwise they don't own it like they do like an hsa. so we also ask -- we think a really hot topic these days is onsite health centers so more and more employees in some cases where they have a lot of

employees are opening or expanding their existing health care -- onsite health clinics and so we ask, do you have one or more of these? and, yes, 37% of our respondents said that they had them. and 16% said they don't but they are considering it. and 47% said for more are planned but that's still a significant number. and if you have one, we ask what services you provide. and the majority not surprisingly, 88% provide occupational health. but 61% -- and this is the big change also now are offering health improvement programs. and even some, 46% provide acute care services so, you know, if you injure yourself or you get a cut or something like that or something has gone wrong and you come in to work and, you know, there's a problem, you can stop in and get it checked out by the

doctor or nurse there or there's a nurse there. it's often staffed by advanced practice nurses, nurse practitioners as they are by physicians but they usually have physicians in part of the time. 38% are offering primary care. so that's a big change. and those are generally in places where there's a dearth of primary care access because they're in more remote locations or just places there are not enough primary care doctors. also 30% provide employee assistance programs and these are counseling services and sometimes help for problems, family problems, you know, you can't get along with your teenager, all sorts you can't get along with your spouse and domestic partner so that's the kind of thing they deal with. so we see more and more onsite services and this is another significant trend. we also see that employers are encouraging the use of centers of excellence.

so instead of just having employees necessarily always just go to the nearest hospital or the hospital that their doctor admits to, more employers are looking into identifying exceptional hospitals or health systems and then encouraging their employees to use those. usually by paying more, a higher proportion of the cost so maybe they have 80% coverage, they might pay 90% if you go to a center of excellence. if they have to travel, they pay the travel costs for the patient and a loved one or a caretaker to go with them. so -- and there's different ways that they do this. this slide on 22 talks about the different ways that they do that. do they reduce or eliminate copace offer the program with the quality. even if they spend more money on

the individual hospital admission, they usually have significantly lower complications, infections, having to redo the operation or having -- or go someplace else a so-called rework so that's why they use those and second opinion services and we also see an interesting new change. employers have been as i mentioned for about the last five years been receiving health improvement programs and being offered a lot of services, not only usually for free but sometimes they're even paid something often in their health account to take advantage of it so they might be given $100, for example, if they take a health assessment and maybe another $100 if they agree to talk to a coach who has identified risk factors for them. and these are not employer directed -- they're not employees of the employer. they are health profession who work for usually the health plan or a special service that

specializes in this. you can see on page 23 you can see online weight management tools, telephonic or online health coaching for weight management so for employees, you can see that 93% offer these to employees. 54% are offering them to spouses or domestic partners and full 33% even to children. so this is quite a big change in what employers are doing. we also -- you can see the online health coaching for weight management, 76% for employees. 57% for spouses of domestic partners and 28% for children. so you can see that there's -- you know, there's a big movement basically to do all of these things. we also have healthy lifestyle

programs in 2012 and the next slide talks about the different ways that you are incentived or employee incentived. so it's cash accounts to participate in healthy lifestyle programs, 58%. incentives and disincentives that are based on tobacco use status where some employees have a nonsmokers discount on the health plan or they may have tobacco use surcharge so they do it both ways. and they also have incentives if you achieve specific health outcomes other than tobacco. so if you lose weight, you participate in weight management programs. some of the other things that they're doing increasingly are in 2012, 76% are using prior authorization for the pharmacy benefit. so if you're -- if you have a prescription for something that is especially very expensive or for only certain clinical

problems and some may be overused you will actually have to have that authorized before it would be dispensed. also they're using quantity limits. an example would be with drugs. so perhaps some of these things you could use more often. you might want to use more often. but they have a limit. there are some -- there's certain medications -- i mean, one of the ones that comes to mind is viagra, where you're only going to get so many of those. they probably didn't ask the people what they wanted, but there would be something where if it's expensive or it should be used in a more moderate way, they'll put limits in. in step therapy which you may be familiar, 65%, this is where there are drugs which are very expensive. and, in fact, should be only for a small group of clinical types but tend to be prescribed more

often. and they put in a requirement saying you have to try the less costly prescription first. and if that doesn't work we will move you to the next one. and in 3 tiered design is another. generics. brand name, formulary brand different ways that try to control the cost prescription drugs. so you can see that there's lots of ways that employers are trying to control costs. we're seeing more and more of a defined contribution model and probably we will see more. much of this is being driven by the understanding that the cadillac tax comes in 2018 and starting last year, employers realize, if they're going to realize paying the really prohibitive cadillac tax, you may recall it's 48% on every dollar after a fixed or capped amount so they've got to take dramatic steps between now and 2018 to avoid the cadillac tax

and they don't intend to plan it we're also adding consumerist type plans so more employers are offering them they're recognizing they don't really have a choice. they've got to do that. and then focusing on comprehensive health improvement initiatives. the weak economy and, unfortunately, we've got even more bad news in the last couple days. the financial and administrative burdens of the health care legislation, uncertainty about the future are all increasing pessimism worry and other health benefits and pay because every dollar that's put into health benefits is $1 in foregone wages or other benefits. and that's what economists always say and i think workers are beginning to understand that. we believe and i think most of our employers understand that we have to. affordibility is tied to

employees premiums and household incomes so they have and we have two really strong arguments for aggressively driving down the health care costs. like the national debt crisis we are struggling to solve. we also have to solve the health care cost crisis and as i'm sure all of you know, they are really intertwined. if we don't solve the health care cost crisis there's no way we're going to solve the national debt crisis. so thank you very much for your time and attention. and we welcome any questions you have. yes, sir. >> is there any sense -- [inaudible] >> well, most of them are, you know, some years ago. but they wouldn't be some years ago if they don't -- if they didn't start acting last year and there's some employers whose plans are so rich that they probably would already hit it if it were in play.

i would cite particularly the public sector. if you go to municipalities and counties and state government and ask them what their individual and their family costs are right now, and you get a correct answer. you'd be shocked at how many are really already virtually there. and certainly will be there long before 2018. yes. >> i had a question about the increase in cost that are projected. can one assume then that premiums would go up the same amount, the 7.2%? >> usually they pass through whatever it is. so it is -- their share would go up 7.2%. all we know is we ask above or below 10% but you can guess that, you know -- the reasonable if you will thing to do would be -- for the employee's share to also go up 7.2%.

and they do on average. their cost-sharing is 20% for premiums. there's some industries and some places in the country like the northeast and manufacturing where the employer pays a higher personally, 85, 87 maybe 90% but the average is 80%. and the industries like retail and other parts of the country, texas, you know -- texas has been in the news lately i don't literally know off the top of my head, cost-sharing is not for the state but for employees and employers tends to be lower. yes. >> could you talk for a limit that average that you mentioned in the beginning? >> yes. >> is that one of your employers in your survey or does that include public -- >> no we get that figure because we did not actually ask the one

in this survey. we get that from our other survey, which we rolled out in march. i can even show you. so, in fact -- many of you also -- rolled this out with towers watson so it's from the 2011 employer survey of purchasing value in health care, towers watson national business group on health and anybody who wants to see that -- you probably have it in your file someplace but i'm sure that ed would be happy to send it to you again. and that's where we got it in. and that information shows the mean and the tenth quartile and all that so it's very detailed. >> i have a question about the annual benefits limits. the survey found 59% employers are not making any changes for 2012.

i assume that means that they're compliant for the most part employers are above the -- [inaudible] >> that's exactly right. yeah, most large employers didn't have any of the limits that are more contemplated in the law. they didn't have them to start with. and if they did, so most of them don't have to make changes and i think that's why. >> 41% do? >> right. well, part of the problem sometimes when you ask this of -- especially of a large employer, large company, they usually have multiple plans. -- i mean, by that i mean -- if they acquired another company, for example, very typically in a lot of big american companies do that i mean, there's been a lot of consolidation so they might have different plans in different parts of the business so they might be on the -- they might have the base plan for the

company and may have very few limits but they might have acquired a company that might have some limits or they might have had a few limits that they decided last year to go ahead and change but it's more that they don't have -- they don't usually have just one plan. >> do you know what that limit is for 2012? >> the benefit limit? yea yeah. >> and it's unlimited and it rises every year and i'm not sure what -- >> yeah, yeah, i don't know that off the top of my head but we can get that answer for you, yeah, yeah. yes. [inaudible] >> what should we be doing to offset potential, you know, disgruntled employees. >> thanks. for those of you on the phone, what about employee morale, well, a couple things, first,

most employers in the last couple years have been making changes. and they always try to help -- have the employees understand why they have to make the changes. and for the most part, employees understand it, because they see it in the news. they see it in their open lives that prices go up and that health care seems to be immune from the normal forces of the market of ups and downs. but they also -- most of them, especially in the last year or two have been saying to them, listen, the consumer-directed health plan will cost you less out of your paycheck. so there's a significant difference in premium so let's say you're in the hmo or you were in a rich ppo plan, an employer puts in a consumer directed health plan, what comes out of their paycheck for that is going go down. and they try to explain to them -- in fact, they usually have cost calculators and they'll say, look, depending on

how you use the health system, you may be better off if you move to a consumer-directed health plan. if you use the system a lot, you've got three or four kids and they all have allergies and asthma and you go to the doctor a lot, then, in fact, you may not be better off in a high deductible consumer directed health plan with or without a health savings account. but if you are fundamentally a low user of the health care system and that your family is to, what you will save out of your paycheck if you take that amount and put it in your health savings account then if you do have -- if you do get sick and you have high expenses, you would have -- you'd have that money. so helping people to understand, they have more control over their use of the system. they have more control over their money, they have the option of taking less out of their paycheck. if you explain it correctly, you know, they're not going to love anything anybody does.

they always want 100% pay for everything and no charge for premiums. so anything that goes away from that is going make somebody unhappy but most of them know that we are in an unsustainable situation. and if -- one of the ironies of what's happened in benefits, health benefits particularly in the last eight years is that it used to be that when you asked employees what's most important in a job, it would usually be like pay, my manager and then there would be a list and then about number six or seven would be health benefits and because health benefits have become more valuable, relative to employees' perception about three or four years ago it hit number 1. that having health benefits was really important and it was partly because they realized how much it cost. if you don't have it. and some of them learned it sadly the hard way when they had a child go off and have to be on cobra or they had a spouse or

domestic partner who lost their job and they were on cobra so they companion to see, you know, this is -- this is a lot of money and my employers have been giving this to me they didn't appreciate it or see it and so it's changed a lot. and now there's more realization if we're going to keep coverage we have to make changes. and, you know, the better the communication the less demoralization. but, you know, we also had this happen during the meltdown when the meltdown occurred and we went into recession a couple of years ago. people changed their views about what was important. many of them said i'm glad i just have a job. and what people are worried about and demoralized about changes especially when we're facing so much economic trauma. i mean, you have a house that is not worth what you owe on it.

you have a child coming from college who can't get a job. i mean, i could go on and on and on. but all of that puts this in perspective in a way that we didn't used to have. >> yes. two things real quick. you mentioned among the taxes the affordable care act requiring coverage for employees children up to the age of 26. and then elimination of a cap on cost. is there any reflection on this whether those have contributed to the increase in the health care costs? >> certainly the age 26 changes and the other changes last year which took effect this year. it was estimated that across the nation it added a full 1

percentage point to trend. which doesn't sound like it is but it is. a full percentage point. you're about the cadillac tax? >> i'm talking about the other provisions. >> yes. for those who had limits of any sort, the ones that had to come off this past year, they definitely would have an increase. now, it may not be a lot because the biggest change was putting overall limit. and thank heavens knock on wood most people don't hit those limits it's not in itself a big cost change but adding kids up to age 26 was a big cost change in our opinion. the other thing that happened that wasn't just that they said you have to cover them until the age of 26, they took away the

requirements for the coverage for young adults. so it used to be that you covered them -- some did it to 23, some to 24, some to 25 but that child had to be financially dependent on the parent, had to be a student. couldn't be working for anybody else et cetera, et cetera. when they put the age 26 they took away all that clear the so they can be lying around the house doing nothing, they can be physicianly dependent on themselves. they can be married. they can children they can work for another employer that has very rich benefits. but they don't have to take it and if they had to pay some cost-sharing they might stay on their parents' coverage paw it wouldn't cost them anything so that's -- you know, that was a

big change. and a change in principle, frankly. >> are either of these things reflected in this survey or a previous surveys? >> the 1%, yes, yes. actually -- i would say that the last year's year -- i mean, this year that would include one full percentage point. yes, yes. and it will -- it continues. >> with that in mind, did any of the employers -- i don't know if this was asked change their pricing structure for family coverage because of that? >> yes. actually, they usually -- most did, but you're right. that is something that did -- do we have a question on that? get the data? but the answer's yes. if they didn't -- if they didn't have a little bit disaggregated -- they didn't go very far, there are a couple of employers who actually charge on a employee per employee per dependent basis but that's very rare but they certainly did so

this is prevalence of different types of tiers and this is and full report that you will have a copy of. so 50 -- or employee only family coverage -- okay. so 85% have family coverage, employee and spouse is 72%. 23% of employee, spouse and children. 12% employee spouse and two children, 9%, so it's still about where it was. there was some disaggregating but not dramatic but i do know there was a fair amount of talk about it. a lot of people kind of grousing about it said, you know, we should change our tiering. in no instance did anyone -- 'cause it wasn't -- you just don't do this for those people who are 23 to 2view we're going to add a category, that's not

the way it works even if you could do it. but if they only had, say, three categories they might have gone to four. but it's certainly something they want to worry about because one of the problems that happens is, you have to internally ask the question of what's equitable. should a parent or a spouse or partner who have four or five children pay the same thing as a woman who's the sole support of her child? and if you have family coverage only, then basically the one with the one child is subsidizing the one with the lot of kids. so there's a lot of -- a lot of talk in the benefits world about what's fair and can we get to the place where if you choose to have four or five children you will pay considerably more than someone who has only one child or two children. >> one other quick thing preventive care the employers

who did have the grandfathered plan and have to add preventive care. is that broken down to see how much that added to the cost? >> no. we don't actually have anything on that at this time. and we don't -- you know, cbo and people like that have done estimates of what the impact of that kind of change would be. but it is not going to be -- it's not going to reduce costs. and it will definitely increase costs. we just don't know by how much. and the big worry that employers have is that every time we open up coverage and we add a visit here and a visit there, two things happen that are very worrisome. the visits themselves cost money. and if -- if everybody did everything at one visit a year, probably it wouldn't be that big of a deal but that's just not

the way it happens but the bigger worry is that the more screenings you do, the more you detect false positives and also you detect problems that worry you to death but really aren't problems it's just you're screening more and you're screening more people and you're screening more asymptomatic people and screening of more asymptomatic people in some ways is very dangerous which is why these adds that you see these people and come in and find out you don't have cancer by having a whole body scan i know you've seen them because we have them in this geographic scan is the worst possible thing. first of all, it can't tell you that. it can't tell you there's nothing wrong with you or there is something wrong but, boy, if you get screened like that, they're going to find lots of stuff. i mean, when they do autopsies at the end of life, they find that people have all sorts of problems in them that never

manifested themselves. and we have a lot of, you know, for like mammograms you can have fatty tissue in the breast that looks like a legion or some sort and you have to go to a biopsy and there's a lot that can happen and it's very important that this screening be only evidence-based and directly related to the gender annual and risk status of the patient. and if you do that, then you're not doing the inappropriate and excessive screening which by the way is also driving up these cost costs. >> another question on the provision to cover, you know, young adult children up to annual 26, you mentioned it's increasing cost by 1%. would you say that employers are bearing that more than employees? and are employers opposed to this? i mean, would they like to see that requirement eliminated? >> well, and it's one percentage point it's not by 1%.

i know that sounds nitpicky but it's really important. it's a full percentage point. well, i think that most employers didn't think that that was a good idea. they weren't asked, i might add. but especially that way i think it would have been much easier if they had just expanded it to 26 but kept the conditions in there because the conditions are reasonable. you could argue especially on the economy and, you know, given the fact that a lot of the uninsured people are kids out of college or out of school or out of work that that might have been one way to deal with the problem of young uninsured. but the problem was more of taking away of reasonable criteria who would be included in that so that -- they would have preferred that it would be more specific. [inaudible] >> yeah, thank you for asking it

again. they are mostly absorbing it because you can only increase costs so much in any given year. [inaudible] >> in terms of how much is spent on health care coverage. is there any -- was there any attempt in either of these surveys to ask employers, is there a way for quantify how much would have been paid in salary if it wasn't going to health care? >> no. but i don't know if they could answered it. they don't have the data systems for that. i think that they would -- they would have a hard time answering that so we wouldn't ask it. but i think it's a really good question. and we do a number of employees situations of employees and we have asked them in the past and

we've seen other surveys that do this to employees, would you rather have more in your pay than in health benefits so if your health benefits were reduced you could get more pay. much i, frankly, think to my own dismay and i think the surprise of a lot of people they said they would rather have the health benefits now it did vary by age, which isn't really surprising when you think about it. younger employees say they would rather have more money. and older employees but on average they still said we'd rather have more on health benefits. and -- i mean, that illustrates a problem in this country when we have this with the medicare debates as well. people don't really understand how much of what's in the health benefits is waste and overuse. and really isn't medically necessary or appropriate. so built into their cost and their foregone wages and benefits are costs that are

wasteful and, you know, if we could get the health care delivery system to change its ways, costs would go down with not employees that would be hurt because nothing could be taken away from them but they would be help because a lot of the ways to reduce costs in this country is improved safety and improved quality. so they'd be better off, there would be fewer death avoidable medical errors and from infections which are avoidable. there would be more focus on services and screenings that are medically appropriate. you wouldn't be getting more than you should be getting. you'd be getting exactly what you should be getting. and we would save money and we have tons of data on this. so it's a problem that people don't understand. you think sometimes when you think at like what's going on with the strike that's going right now, you know, they're in there saying we want more benefits. and, you know,, in fact, they

could get more wages if they changed some of the things in their benefit package to improve the productivity of the investment. you know, the return on the investment, but that's not part of the debate everybody thinks give me more. medicare, you look what's going on with the national debt crisis and the reaction is, don't touch my medicare. well, we could actually save hundreds of billions of dollars in medicare and we would not be hurting the beneficiaries. in fact, we'd be helping them. but nobody wants to deal with that. politically or in terms of the industries would have to change quite a lot. for that to happen. i did see there was one great quote -- i would -- i can't resist this because some of you may have seen this morning's "new york times." there's a story about health jobs and how -- there's been health care that's been growing and, of course, as employers we see -- if health care grows that's charging us more.

so while it's jobs it's also incomes and that means costs. but this whole thing was about how the health industry is going to be have to begin think more parsimoniously like industry has and there's one head of a hospital who said, while he expects for the demand of health care services rise this is for health care reform he believes he needs to deliver that with fewer costs. here's what his quote i think that's what the nation is asking from all of us. we are together as employers, we're trying to move this battleship in the direction of improving quality safety and utilization of correct services while we also reduce costs and we can do that and these data are actually aimed -- these steps, the tactics they are taking are aimed at trying to do that for the 160 million peo